Jeong Ho Kim1, Yong Hyun Park1, Yong June Kim2, Seok Ho Kang3, Seok Soo Byun4, Cheol Kwak5, Sung Hoo Hong6. 1. Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. 2. Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Korea. 3. Department of Urology, Korea University School of Medicine, Seoul, Korea. 4. Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea. 5. Department of Urology, Seoul National University Hospital, Seoul, Korea. 6. Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea. toomey@catholic.ac.kr.
Abstract
PURPOSE: We compared perioperative and long-term renal functional outcomes of robot-assisted partial nephrectomy (RAPN) with laparoscopic partial nephrectomy (LPN) for small renal masses. MATERIALS AND METHODS: A total of 1,032 patients were included for evaluation; propensity score matching was performed to adjust for potential baseline confounders, which resulted in 195 LPNs matched to 195 RAPNs. Patient characteristics including preoperative estimated glomerular filtration rate (eGFR) were investigated, and postoperative results were evaluated. RESULTS: No significant differences were found between the groups with regard to age, body mass index, sex distribution, preoperative eGFR, or tumor size. The mean follow-up period was 32.4 ± 21.1 months for LPN patients versus 31.1 ± 24.5 months for RAPN patients (p = 0.589). Operative time (p < 0.001) and warm ischemic time (p < 0.001) were significantly shorter in the RAPN group. No significant differences were observed in the overall change in eGFR (p = 0.768) or positive surgical margin rate (p = 0.653). A multivariate analysis showed that preoperative eGFR and hypertension significantly influenced the risk of stage 3 and 4 chronic kidney disease. A significant deterioration in renal function occurred 3 months after surgery. However, renal function increased gradually after the nadir eGFR was reached. The amount of renal functional recovery was higher in the RAPN group. CONCLUSIONS: Operative parameters for RAPN appear to be less affected by tumor complexity. Functional outcomes of RAPN were superior to those of LPN. Renal function recovered continuously during the 60-month follow-up period after partial nephrectomy.
PURPOSE: We compared perioperative and long-term renal functional outcomes of robot-assisted partial nephrectomy (RAPN) with laparoscopic partial nephrectomy (LPN) for small renal masses. MATERIALS AND METHODS: A total of 1,032 patients were included for evaluation; propensity score matching was performed to adjust for potential baseline confounders, which resulted in 195 LPNs matched to 195 RAPNs. Patient characteristics including preoperative estimated glomerular filtration rate (eGFR) were investigated, and postoperative results were evaluated. RESULTS: No significant differences were found between the groups with regard to age, body mass index, sex distribution, preoperative eGFR, or tumor size. The mean follow-up period was 32.4 ± 21.1 months for LPNpatients versus 31.1 ± 24.5 months for RAPN patients (p = 0.589). Operative time (p < 0.001) and warm ischemic time (p < 0.001) were significantly shorter in the RAPN group. No significant differences were observed in the overall change in eGFR (p = 0.768) or positive surgical margin rate (p = 0.653). A multivariate analysis showed that preoperative eGFR and hypertension significantly influenced the risk of stage 3 and 4 chronic kidney disease. A significant deterioration in renal function occurred 3 months after surgery. However, renal function increased gradually after the nadir eGFR was reached. The amount of renal functional recovery was higher in the RAPN group. CONCLUSIONS: Operative parameters for RAPN appear to be less affected by tumor complexity. Functional outcomes of RAPN were superior to those of LPN. Renal function recovered continuously during the 60-month follow-up period after partial nephrectomy.
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